(CS-106) An Unusual Complication of Dermatillomania: Amputation of Two Toes

Friday, April 10, 2026

Pavlo Kolyesnykov, DPM – Podiatrist, Northern Illinois Foot & Ankle Specialists; Peter Lovato, DPM – Podiatrist, Northern Illinois Foot & Ankle Specialists; Rimi (Rimvydas) Statkus, DPM – Podiatrist, Northern Illinois Foot & Ankle Specialists

Introduction: Dermatillomania or skin picking disorder (SPD) is a repetitive skin picking practice leading to tissue damage, infection, and possibly more serious health consequences. Discovering the underlying cause can be difficult because the overlying skin damage may mask the underlying primary lesion. The aim of this preliminary report is to report a unique case on dermatillomania leading to the amputation of toes and emphasize the importance of multidisciplinary treatment approach.

Methods: A 64 year old female patient presented with skin injury to her hallux and 3rd toe. She had a history of poorly controlled diabetes, anxiety, depression, and prior psychiatric evaluations. She was treated for her psychiatric conditions with poor adherence to the treatment regimen. She was treated with wound care management. Upon poor adherence to provided treatment, the patient developed deep wounds to her right foot toes. Subsequently, the patient developed a deep infection with suspicion for osteomyelitis. The patient was admitted to the hospital for advanced imaging, intravenous antibiotics, and further management. Magnetic resonance imaging confirmed osteomyelitis. Amputations of the right hallux and 3rd toe were performed. The patient was instructed to avoid picking at the skin and to apply a bland moisturizer twice daily to help the surgical sites heal. Semi-occlusive dressings were also found to be beneficial.

Results: Psychiatry was consulted to manage dermatillomania disorder. The treatment regimen was targeted with a multidisciplinary approach. Wound care and close outpatient follow-up were continued. The patient was able to adhere to the treatment and achieve complete healing of the surgical sites without complications.

Discussion:
SPD is a prevalent disorder, which can have potentially serious health consequences. Many patients lack insight into their condition. Our case demonstrates that patients with repetitive lower extremity picking may develop wounds that can lead to infections and ultimately to a limb loss. This particular case highlights the need for a multidisciplinary approach when evaluating and caring for patients with SPD and associated wounds. It is crucial to exclude other medical or psychiatric conditions. These patients will benefit from a referral to the psychiatric team.